Illinois
LLC-45.20
Form
Limited Liability Company Act
FILE #
December 2004
a. Application for Registration of Name
Secretary of State Jesse White
b. Renewal of Registered Name
This space for use by Secretary of State.
Department of Business Services
c. Cancellation of Registered Name
Print
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Limited Liability Division
Room 351 Howlett Building
SUBMIT IN DUPLICATE
501 S. Second St.
Must be typewritten
Springfield, IL 62756
This space for use by Secretary of State.
Payment may be made by business
Filing Fee: $
a. $300 b. $100 c. $100
firm check payable to Secretary of State.
(If check is returned for any reason this
Approved:
filing will be void.)
1. Limited Liability Company name: __________________________________________________________________
____________________________________________________________________________________________
2. State or country of organization: ___________________________________________________________________
3. Date of organization: ____________________________________________________________________________
4. Purpose for which the Limited Liability Company was organized: (Include Business Code # from IRS form 1065.)
5. Post-office address to which may be mailed notices by the Secretary of State: _____________________________
______________________________________________________________________________________________
6. Federal Employer Identification Number (F.E.I.N.): _____________________________________________________
7. The Limited Liability Company desires to register its name pursuant to Section 45-20, and it is NOT transacting business
in the State of Illinois.
8. If the purpose of this submission is to register a name or to renew a registered name, a certificate not more than 30 days
old must be attached stating that the Limited Liability Company is in good standing under the laws of the state or country
wherein it is organized.
9. Such registration or renewal of registration shall be effective from the date of filing by the Secretary of State until the first
day of the 12th month following such date.
10. The cancellation shall be effective upon filing with the Secretary of State.
11. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this application is to the best
of my knowledge and belief, true, correct and complete.
,
________________________________ , _________
Dated
Year
Month/Day
.
_______________________________________________
Signature
_______________________________________________
Name and Title (type or print)
_______________________________________________
If applicant is a company or other entity, state name of company
and indicate whether it is a member or manager of the LLC.
Printed by authority of the State of Illinois. February 2005 –1M – LLC-6.3
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